Provider Demographics
NPI:1770585168
Name:HARTMAN, SHELLEY R (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 WILLAGILLESPIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2186
Mailing Address - Country:US
Mailing Address - Phone:541-484-5437
Mailing Address - Fax:
Practice Address - Street 1:995 WILLAGILLESPIE RD STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2186
Practice Address - Country:US
Practice Address - Phone:541-484-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19144208000000X
PAMD463409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080213Medicaid
G13437Medicare UPIN
OR080213Medicaid